Protocol .uk
Protocol
Royal Alexandra Hospital Chest Pain Assessment Unit (CPAU)
If HEART Score 5 page 2nd on 56228 to arrange admission.
N.B 2nd on may decide to admit to CPAU if bed not immediately available in CCU
Out of hours (17.30 to 08.30) follow current pathway and phone 2nd on.
All CPAU admissions to be discussed with ED senior who may decide to admit to CPAU irrespective of HEART Score
|HEART score for chest pain patients |
|History |Highly suspicious |2 | |
| |Moderately suspicious |1 | |
| |Slightly suspicious |0 | |
|ECG |Significant ST-depression |2 | |
| |Non specific repolarization disturbance |1 | |
| |Normal |0 | |
|Age |≥ 65 year |2 | |
| |45 – 65 year |1 | |
| |≤ 45 year |0 | |
|Risk factors |≥ 3 risk factors or history of atherosclerotic disease |2 | |
| |1 or 2 risk factors |1 | |
| |No risk factors known |0 | |
|Troponin (In ED assume |≥ 3x normal limit |2 | |
|normal unless result | | | |
|available due to delay) | | | |
| |1-3x normal limit |1 | |
| |≤ normal limit |0 | |
|Total | |
History
If the history is regarded as slightly suspicious or non-specific = 0 point.
If the history is regarded as moderately suspicious in that
it contains both nonspecific and suspicious elements = 1 point
If the history is regarded as highly suspicious = 2 points.
A highly suspicious history should contain mainly elements, such as middle- or left-sided, heavy chest pain, radiation, and/or definite relief of symptoms by GTN
ECG scoring. Where possible compare with previous ECG on MUSE.
Score is not additive use highest score
Normal ECG = 0 points.
Repolarisation change + no significant ST-seg. depression/elevation = 1 point.
Bundle branch block, pacemaker rhythm, typical abnormalities
indicative of left ventricular hypertrophy = 1 point
Repolarisation abnormalities probably caused by digoxin use = 1 point
Unchanged repolarisation disturbances = 1 point
Significant ST-segment depressions or elevations
in absence of a bundle branch block,
left ventricular hypertrophy, or the use of digoxin = 2 points
T wave inversion (outwith v1+v2) not known to be established = 2 points
Findings of infarction or ischemia not known to be old = 2 points
Risk Factors
currently treated diabetes mellitus, current or recent (30), or a history of significant atherosclerosis (coronary revascularization, myocardial infarction, stroke, or peripheral arterial disease, irrespective of the risk factors for coronary artery disease).
no risk factors at all = 0 points
1 or 2 risk factors, = 1 point
3 or more risk factors or had a history of significant atherosclerosis = 2 points
-----------------------
Date:
Time 24 hour clock :
Insert Patient Label here
Inclusions to be met for admission : Please Circle
The principal symptom should be “chest pain” of possible cardiac origin Y
Patient must be pain free Y
HEART Score 5 but sanctioned by ED Senior Y
Exclusions – all must be NO: Please Circle
Ongoing Pain, or required morphine to relieve pain N
STEMI N
Reasonable suspicion of significant non-cardiac diagnosis N
NEWS >3 (discuss with senior if chronic) N
Complex co-morbidities/frailty likely necessitating admission N
Co-existing conditions that likely necessitate admission N
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h€t`5?OJQJh|Aàh€t`H*[pic]e.g. Heart Failure or new onset AF
Pregnancy N
Process: TICK
Clerk on usual medical proforma [pic]
Send bloods – AMED including initial Troponin [pic]
Send for CXR on way to CPAU [pic] There is no need to wait for Troponin result
Insert Patient Label here
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